Self-Reported Rationing Behavior Among US Physicians: A National Survey

• Published in: Journal of general internal medicine : JGIM 2016-12, Vol.31 (12), p.1444-1451
• Main Authors: Sheeler, Robert D., Mundell, Tim, Hurst, Samia A., Goold, Susan Dorr, Thorsteinsdottir, Bjorg, Tilburt, Jon C., Danis, Marion
• Format: Article
• Language: English
• Subjects: Adult; Attitude of Health Personnel; Behavior; Cross-Sectional Studies; Design factors; Drugs; Female; Health care; Humans; Internal Medicine; Magnetic resonance imaging; Male; Medical personnel; Medicine; Medicine & Public Health; Middle Aged; Original Research; Personal communication; Physicians; Physicians - economics; Physicians - psychology; Practice Patterns, Physicians' - economics; Primary care; Rationing; Self Report; Subgroups; Surgery; Surveys and Questionnaires
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-016-3756-5

Background Rationing is a controversial topic among US physicians. Understanding their attitudes and behaviors around rationing may be essential to a more open and sensible professional discourse on this important but controversial topic. Objective To describe rationing behavior and associated factors among US physicians. Design Survey mailed to US physicians in 2012 to evaluate self-reported rationing behavior and variables related to this behavior. Setting US physicians across a full spectrum of practice settings. Participants A total of 2541 respondents, representing 65.6 % of the original mailing list of 3872 US addresses. Interventions The study was a cross-sectional analysis of physician attitudes and self-reported behaviors, with neutral language representations of the behaviors as well as an embedded experiment to test the influence of the word “ration” on perceived responsibility. Main Outcome Measures Overall percentage of respondents reporting rationing behavior in various contexts and assessment of attitudes toward rationing. Key Results In total, 1348 respondents (53.1 %) reported having personally refrained within the past 6 months from using specific clinical services that would have provided the best patient care, because of health system cost. Prescription drugs ( n  = 1073 [48.3 %]) and magnetic resonance imaging ( n  = 922 [44.5 %]) were most frequently rationed. Surgical and procedural specialists were less likely to report rationing behavior (adjusted odds ratio [OR] [95 % CI], 0.8 [0.9–0.9] and 0.5 [0.4–0.6], respectively) compared to primary care. Compared with small or solo practices, those in medical school settings reported less rationing (adjusted OR [95 % CI], 0.4 [0.2–0.7]). Physicians who self-identified as very or somewhat liberal were significantly less likely to report rationing (adjusted OR [95 % CI], 0.7 [0.6–0.9]) than those self-reporting being very or somewhat conservative. A more positive opinion about rationing tended to align with greater odds of rationing. Conclusions More than one-half of respondents engaged in behavior consistent with rationing. Practicing physicians in specific subgroups were more likely to report rationing behavior.